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Neoadjuvant chemoradiotherapy with radiation dose escalation with contact x-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2–cT3 rectal adenocarcinoma (OPERA): a phase 3, randomised controlled trial

Gerard J-P, Barbet N, Schiappa R, Magne N, Martel I, Mineur L et al, on behalf of the ICONE group.

Lancet Gastrohepatol 2023; 8: 356-367.

This study explored whether a radiotherapy booster was beneficial in 148 patients with a complete response to neoadjuvant chemoradiotherapy. Three-year preservation of the rectum was more likely after contact brachytherapy (81 per cent) versus 59 per cent for booster external beam radiotherapy, P=0.0026. The effect was greatest for tumours <3cm in diameter.

Comment: Management of rectal tumours with the aim to avoid ablative surgery is evolving.

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